factors associated with acute coronary syndrome …

INTEGRATIVE REVIEW

DOI: 10.18554/reas.v7i3.3511

Rev Enferm Health Care [Online]. Jan/Jul 2020; 9(1):160-172 ISSN 2317-1154

FACTORS ASSOCIATED WITH ACUTE CORONARY SYNDROME AND ITS

PREVALENCE AMONG GENDERS: INTEGRATIVE REVIEW

FATORES ASSOCIADOS A SÍNDROME CORONARIANA AGUDA E SUA

PREVALÊNCIA ENTRE OS GÊNEROS: REVISÃO INTEGRATIVA

LOS FACTORES ASOCIADOS CON EL SÍNDROME CORONARIO AGUDO Y SU

PREVALENCIA ENTRE SEXOS: REVISIÓN INTEGRADORA

Kaiomakx Renato Assunção Ribeiro1, Thales Antônio Martins Soares2, Maria Madalena Borges3,

Edivalda Pereira de Abreu4, André Rodrigues dos Santos5, Fernanda Alves Ferreira Gonçalves6

RESUMO

Objetivo: discutir sobre os fatores associados à Síndrome Coronariana Aguda, bem como sua

prevalência entre homens e mulheres. Método: estudo do tipo, revisão integrativa da literatura,

com busca dos artigos nas bases de dados LILACS, SciELO, BDENF, PUBMED, publicados entre

2012 e 2018. Resultados: foram encontrados inicialmente 502 artigos, dos quais, 20 compuseram

esta pesquisa. O tabagismo foi o fator de risco mais prevalente no surgimento da Síndrome

Coronariana Aguda, seguido da Hipertensão Arterial Sistêmica. Os pacientes acometidos por esta

doença apresentaram como características dois ou mais fatores de riscos. O gênero masculino foi

o que apresentou maior prevalência para esta patologia. Conclusão: são vários os fatores de riscos

para o surgimento da Síndrome Coronariana Aguda e o seu surgimento parece estar associado a

presença de dois ou mais fatores de riscos, o que denota a necessidade de uma maior ênfase na

educação da população sobre a prevenção desses fatores.

Descritores: Infarto do miocárdio; Síndrome coronariana aguda; Epidemiologia; Prevalência.

ABSTRACT

Objective: discuss the factors associated with acute coronary syndrome, as well as its prevalence

among men and women. Method: study of the type, integrative review of the literature, with search

of articles in databases LILACS, SciELO, BDENF, PUBMED, published between 2012 and 2018.

Results: initially were found 502 articles, of which 20 comprised this study. Smoking was the most

prevalent risk factor in the occurrence of acute coronary syndrome, followed by systemic

hypertension. Patients affected by this disease presented as two or more risk factors. The male

gender was presented the highest prevalence for this pathology. Conclusion: There are several risk

factors for the onset of acute coronary syndrome and its appearance seems to be associated with

the presence of two or more risk factors, which denotes the need for a greater emphasis on the

education of the population on the prevention of these factors.

Descriptors: Myocardial infarction; Acute coronary syndrome; epidemiology; prevalence.

RESUMEN

Objetivo: discutir sobre los factores asociados al Síndrome Coronaria Aguda, así como su

prevalencia entre hombres y mujeres. Método: el estudio del tipo, revisión integrativa de la

literatura, con búsqueda de los artículos en las bases de datos LILACS, SciELO, BDENF,

PUBMED, publicados entre 2012 y 2018. Resultados: se encontraron inicialmente 502 artículos,

20 de los cuales constaba de este estudio. El tabaquismo fue el factor de riesgo más prevalente en

la ocurrencia de síndrome coronario agudo, seguido por hipertensión arterial sistémica. Los

pacientes afectados por esta enfermedad presentan como dos o más factores de riesgo. El sexo

____________________ 1 Enfermeiro pela -UNIVERSO-GO. Pós-graduação em UTI, Cardiologia e Hemodinâmica, Residente de

Enfermagem, modalidade Terapia Intensiva pela SES do Distrito Federal-SES-DF. Hospital de Base do Distrito

Federal-HBDF. Escola Superior de Ciências da Saúde-Distrito Federal-ESCS-DF. 2 Mestre em Enfermagem pela UFG - Goiás - GO. 3 Enfermeira pela Universidade Católica de Goiás, Especialista em administração hospitalar. Universidade Salgado de Oliveira UNIVERSO-GO. Pontifícia Universidade Católica de Goiás-PUC-GO. 4 Enfermeira doutoranda pela Pontifícia Universidade Católica de Goiás, Docente do curso de enfermagem da

Universidade Salgado de Oliveira, Goiânia-GO, Brasil. 5 Escola Superior de Ciências da Saúde-Distrito Federal –ESCS-DF. 6 Enfermeira. Mestranda em Enfermagem do Programa de Pós Graduação em Enfermagem da Faculdade de

Enfermagem da Universidade Federal de Goiás (PPG/FEN/UFG). Enfermeira do Hospital das Clínicas da UFG.

Goiânia-Goiás.

161


masculino se presentó la mayor prevalencia de esta patología. Conclusión: Existen varios factores

de riesgo para la aparición de síndrome coronario agudo y su aspecto parece estar asociado con la

presencia de dos o más factores de riesgo, lo que denota la necesidad de un mayor énfasis en la

educación de la población sobre la prevención de estos factores.

Descriptores: Infarto del miocardio; Síndrome coronario agudo; epidemiologia; prevalencia.

INTRODUCTION

Cardiovascular diseases are the main

responsible for the increase in morbidity and

mortality of the greater part of the population.

Among these, we highlight the acute

coronary syndrome (ACS) or acute

myocardial infarction (AMI), pathology

causing several deaths in developed and

developing countries, responsible for over

30% of deaths in Brazil. Therefore, AMI can

be considered as an important indicator of

quality standards of policies on collective

health to be a disease of great impact.1-2

The AMI diagnosis is confirmed

through the electrocardiogram (ECG) and

should be performed at the time of up to 10

minutes after the arrival of the patient in the

hospital.2 It is observed on this exam that

AMI can change the electrocardiographic

records and be classified as AMI with

elevation of the ST segment (IAMCST) or

without elevation of the same follow-up

(IAMSST).1

In Brazil, according to data from the

Sistema Único de Saúde (DATASUS) and the

Ministry of Health, there were 84,945 deaths

due to ischemic heart disease in 2005. In

2008, the systems of information recorded

518 hospitalizations for AMI in Rio Grande

do Sul. In the United States, approximately

1.5 million patients each year develop AMI,

of which 40% to 50% are accompanied

by presenting ECG with ST segment

elevation (IAMCST).3

Statistically, between 25 to 30% of the

AMI do not have fatal outcomes, being that

the clinical symptoms are not recognized by

the patient, but identified with efficiency by

routine ECG or at post-mortem

examination. Therefore, the ECG associated

with a good clinical history and physical

examination is fundamental for the patient

with chest pain, because in addition to the

cost low, its implementation is simple and

allows the immediate assessment of the result

of the examination.3

In the year 2009, the AMI was the third

largest cause responsible for hospitalizations

in the Unified Health System (SUS). This

represented a total of 10.2% of

hospitalizations, number that exceeds 25%

when analyzed the population over the age of

50 years.4

In 2011, Coronary Artery Disease

(CAD), was responsible for a every seven

deaths in the United States. In the same

year, 375,295 Americans died of this

pathology. Annually, it is estimated that

635,000 new coronary attacks occur, 300,000

recurrent attacks, in addition to 155,000

additional went silent in the American

population. It is also important to emphasize

that approximately every 34

seconds, an American presents a coronary

event, and about one minute and 24 seconds,

a death occurs in this population.5

However, the hospital mortality in

relation to IAMCST showed significant

decrease of 11.5% in the year 1990, 8.0% for

the year 2006. attaches to this decline factors

such as advances in clinical pharmacotherapy

and the reperfusion strategies, such as

percutaneous coronary intervention (PCI)

primary, and also to changes of patients in

162


regard to their demographic profile and the

response time between onset of symptoms

and the demand for specialized help.6

It is worth noting that, despite the

reduction in mortality due to AMI in the intra-

hospital phase, the incidence of deaths by this

pathology is still significant in the prehospital

environment. This high mortality, especially

in Brazilian metropolises, represents a

considerable socioeconomic impact for the

country.7

As regards the most prevalent risk

factors for the onset of AMI, we

highlight the Systemic Arterial Hypertension

(SAH), smoking (SM), diabetes

mellitus (DM), alcoholism and the

dyslipidemia.1.8 important to stress that SAH

is considered as the main risk factor of

AMI, in addition to evident as an expressive

index of hospital mortality in patients with a

definitive diagnosis of AMI.2

In this way, this study aimed to discuss

the factors associated with acute coronary

syndrome, as well as a review of the current

literature brings about the prevalence of acute

coronary syndrome/acute myocardial

infarction (SCA/AMI) between men and

women.

Face it, this study is justified by the fact

that the SCA/would be a reality in current

scenario. Thus these data may serve as a

warning to the health professionals regarding

the need for health education to the

population, in addition to stimulate demand

an immediate hospital unit in the initial

presence of signs and symptoms of AMI. In

addition, this study can promote the

knowledge of health professionals about this

theme and to awaken the attention for its

prevention, combat and control.

Methodology

It is a descriptive and exploratory

study of integrative review of literature of

epidemiological studies, in which they were

covered six inter-related steps: establishment

of hypothesis or guiding question, sampling

or search in the literature, categorization of

the study, assessment of studies included in

the review, interpretation of results, synthesis

of knowledge or presentation of the review.

For the elaboration of the guiding

questions was used in the research strategy

peak, which represents an acronym for (P) or

patient population, (I) Intervention, (C)

control or comparison, (O) "outcomes"

(outcome). So the guiding questions were:

What are the factors associated with the

development of acute coronary syndromes

have been described in the literature? Which

its prevalence among men and women in the

current scenario?

Subsequently, conducted the survey

of articles between March and July of 2018,

the databases Medline data Public

or Publisher Medline (Pubmed), Latin

American and Caribbean Literature in Health

Sciences (LILACS), Scientific

Electronic Library Online (SciELO) and the

Nursing Database (BDENF), using the

following Descriptors in Health Sciences

(Decs): myocardial infarction, acute coronary

syndrome and prevalence. As descriptors of

the Medical Subject Headings (Mesh) were

used: Myocardial Infarction, Acute Coronary

Syndrome Prevalence. Thus, the search was

performed using the following strategies:

Myocardial infarction and acute coronary

syndrome and prevalence or epidemiology,

((("Myocardial

Infarction"[Mesh]) AND "Acute Coronary

Syndrome" [Mesh]) AND "Health" [Mesh])

163


or ((("Myocardial

Infarction"[Mesh]) AND "Acute Coronary

Syndrome" [Mesh]) AND

"Epidemiology"[Mesh].

The inclusion criteria were: studies

available in their entirety, observational,

descriptive, analytical; made with human

rights in the context of clinical practice, in

which the authors are health professionals

(nurses, doctors, pharmacists and

physiotherapists), which addressed the

epidemiology or the prevalence of SCA/AMI

and the risk factors associated with its

development. As an exclusion criterion

adopted: articles that addressed the theme

proposed, pulicados texts on websites, brief

communications, theses, dissertations or

theses and articles pulicados preceding the

year of 2012. Articles with dual publication

or articles available in two or more databases

were considered only once .

The selection of the studies gave

himself by means of consensus among the

researchers of this study, to evaluate the goals

and the main results presented by them. The

path followed in the search and selection of

studies was presented in figure 1 and the

results found, were presented in the form of

tables (Table 1 and Table 2). The selected

studies were characterized as descriptive,

observational studies that have addressed the

topic SCA or AMI and analyzed the risk

factors present in your appearance.

Figure 1. Search and selection of studies based on the PRISMA model diagram.

RESULTS Initially, the search resulted in 502

studies. Of this total, 459 studies were

excluded after adopting the exclusion criteria

Studies identified through the search in the database (n = 502)

LILACS (n=49) SCIELO (n=7)

PUBMED (n=440)

Studies after application of filters and removal of

duplicates (n=148)

Articles included (n=148) Articles excluded (n=105)

Articles (full texts) for

evaluation of eligibility

(n=43)

Articles excluded because

they did not meet the

proposed objective (n=23)

Corpus of research

(n=20)

Iden

tifi

cati

on

S

elec

tion

E

ligib

ilit

y

Incl

ud

ed

DDENF (n=6)

164


described above. The 43 remaining studies

were submitted to complete reading, which

enabled the delete over 23 studies because

they do not meet the objective of this study.

To analyze the results, we noticed that

the variables with greater incidence among

patients with AMI were: SAH, TB and DM.

Among the variables prevalent and cited by

the authors is the SAH, reported in 100% of

articles as the pathology that affects patients

with infarction. A situation that requires

attention on the part of professionals and

managers of health, aimed at controlling the

tensor levels of the population already

affected, reduce new cases by means of

educational strategies and, consequently,

reduce new cases of AMI.

When analyzing the smoking as a risk

factor observed variations in its incidence

according to the publications. The studies

pointed out as the second variable more

frequent among patients who developed

AMI. These causes (hypertension and

smoking), along with the other variables, may

make them more complex and vulnerable to

the development of a new cardiac event and

even more serious.

Among the risk factors for AMI more

incidents in the literature selected are the TB,

hypertension, diabetes, obesity and sedentary

lifestyle. It was evident that it was common

the presence of two or more risk factors

together, present in the same patient, in the

onset of signs and symptoms of AMI.

Therefore, it is observed that the risk factors

alone are relevant for the development of

AMI, however, when in conjunction with

other risk factors, driving even further the risk

of AMI.

In relation to the incidence of AMI by

genres, 94% of the studies analyzed showed a

higher incidence of this pathology in males,

ranging from 52.1% to 78.1. The female

gender was also very expressive, however,

less incident, ranging from 21.9% to 47.9%

of cases occurred as the studies. However, it

became apparent that there was an increase in

the incidence of cases of ACS in females in

recent years.

165


Table 1 - Prevalence of acute coronary syndrome among men and women according to the selected publications. 2018.

Authors, Year Title Sample Literacy (%) Males (%)

Bahall, Seemungal, Legall,

2018.9

Risk factors for first-time acute myocardial infarction patients in Trinidad 252 113 (45%) 138 (55%)

Fernández-

Rodríguez et al., 2017.10

Gender gap in medical care in ST segment elevation myocardial infarction networks: Findings from the

Catalan network Codi Infart 4380 961 (21.9%) 3419 (78.1%)

Marino et al., 2016.11 Epidemiological profile and Quality Indicators in patients with Acute Coronary Syndrome in Northern

Minas Gerais Minas Telecardio 2 Project 277 95 (34.3%) 182 (65.7%)

Araújo et al., 2016.2 Profile of the population affected by acute myocardial infarction 106 36 (34%) 70 (66%)

Andrade et al., 2015.6 Clinical and angiographic profile of young patients primary percutaneous coronary intervention

489 151 (30.9%) 338 (69.1)

Maier, Martins, Dellaroza,

2015.12

Pre hospital indicators in assessing the quality of care for patients with acute coronary syndrome 94 45 (47.9%) 49 (52.1%)

Soeiro et al., 2015.13 Clinical characteristics and long-term progression of young patients with acute coronary syndrome in Brazil.

268 115 (43%) 153 (57%)

Andrade et al., 2015.14 The assessment of the time of the initial electrocardiogram in patients with acute coronary syndrome

116 53 (45.7%) 63 (54.3%)

Sousa et al., 2015.15 Epidemiology of coronary artery bypass grafting at the Hospital Beneficência Portuguesa, São Paulo 3011 906 (30.1%) 2105 (69.9%)

Almeida et al., 2014.16 Comparison of clinical-epidemiological profile between men and women in acute coronary syndrome 927 556 (60%) 371 (40%)

Araújo et al., 2014.17 Clinical and epidemiological profile of patients with acute coronary syndrome 150 52 (34.7%) 98 (65.3%)

Jesus, Campelo,

Silva, 2013.1

Profile of patients admitted with acute myocardial infarction in the Emergency Hospital of Teresina-PI 240 105 (43.8%) 135 (56.2%)

166


Lima et al., 2018.18 Clinical-epidemiological aspects of patients submitted to percutaneous coronary intervention in the

university hospital 222 77 (34.7%) 145 (65.3%)

Deora et al., 2016.19 Demographic and angiographic profile in premature cases of acute coronary syndrome: analysis of 820

young patients from South India 820 60 (7.3%) 760 (92.7%)

Agrawal et al., 2016.20 Clinical Profile with angiographic correlation in Naïve Acute Coronary Syndrome 100 25 (25%) 75(75%)

Silva et al., 2018.21 Epidemiological and clinical profile of patients with acute coronary syndrome

145 166 (54.8%) 201

(45.2%)

Andamans et al., 2016.22 Evaluation of algorithms is registry-based detection of acute myocardial infarction following percutaneous

coronary intervention 5719 1448 (25.3%) 4271 (74.7%)

Pogorevici et al., 2016.23 Canada acute coronary syndrome score was a stronger predictor than baseline age ≥75 years of in-hospital

mortality in acute coronary syndrome patients in western Romania 960 211 (22%) 749 (78%)

Fonte: authors, 2018.

167


Table 2 - Characteristics of the articles regarding the profile of patients with AMI, 2018.

Authors Sample Sedentary

Lifestyle

Arterial

hypertension Dyslipidemia

Diabetes

Mellitus Alcoholism Smoking

Family

History

Obesity/

overweight Stress

Bahall, Seemungal, Legall, 2018.9 251 X 185 (73.7%) 49 (19.8%) 158 (63.0%) 81 (32.3%) 85 (33.9%) 76 (30.3%) X 63 (25.1%)

Hayıroğlu et al., 2018.24 142 X 67 (47.2%) 54 (38.0%) 73 (51.4%) X 87 (61.3%) X X X

Grieshaber et al., 2018.25 434 X 410 (94.5%) 287 (66.1%) 172 (39.6%) X X X X X

Ong et al., 2017.26 1690 X 693 (41%) 467 (27.6%) 289 (17.1) X 555 (32.8%) 185 (10.9%) X X

Fernandes-Rodrigues et al., 2017.10 961 X X X 260 (27.1%) X X X X X

Araújo et al., 2016.2 106 X 88 (83%) X 42 (39.6%) 8 (7.6%) 33 (31.2%) X X X

Marino et al., 2016.11 583 X 462 (79.2%) 324 (90.5%) 139 (23.8%) 139 (23.8%) 116 (19.9%) 235 (40.3%) X X

Mozaffarian et al., 2015.5 489 X 325 (66.5%) 155 (31.7%) 153 (14.8%) X 215 (44%) 91 (18.6%) 113 (23.1%) X

Soeiro et al., 2015.13 268 X 182 (68%) 115 (43%) 67 (25%) X 180 (67%) X X X

Andrade et al., 2015.14 116 46 (39.3%) 63 (54.4%) 36 (31.1%) X X 9 (7.8%) 19 (16.3%) X X

Schmidt et al., 2015.27 1817 X 1175 (64.7%) 649 (35.7%) 438 (24.1%) X 761 (41.9%) 552 (30.4%) X 3 (0.2%)

Sousa et al., 2015.15 3010 X 2491 (82.8%) 1338 (44.5%) 1102 (36.6%) X 1665 (55.3%) 881 (29.3%) 620 (20.6%) X

Araújo et al., 2014.17 150 1 (0.7%) 102 (68%) 2 (1.3%) 8 (5.3%) 1 (0.7%) 36 (24%) X X X

Almeida et al., 2014.16 927 598 (64.5%) 679 (73.2%) 544 (58.7%) 350 (37.8%) 181 (19.5%) 194 (20.9%) X X X

Jensen et al., 2018.28 3209 X 1724 (53.78%) X 702 (21.9%) X 1252 (39%) X 553 (17.2%) X

Lima et al., 2018.18 222 202 (91%) 178 (80.2%) X 85 (38.3%) 48 (21.6%) 121 (54.5%) 85 (38.3%) 55 (24.8%) X

Agrawal et al., 2016.20 100 X 21 (21%) X 23 (23%) X 18 (18%) 11 (11%) 21 (21%) X

Deora et al., 2016.19 820 X 140 (17.1%) 685 (83.5%) 115 (14%) X 561 (68.4%) 62 (7.6%) 111 (13.5%) X

Silva et al., 2018.21 367 X 229 (62.4%) 87 (23.7%) 51 (13.9%) 117 (31.9%) 114 (31%) X X X

Pogorevici et al., 2016.23 960 X 414 (43.1%) 297 (30.9%) 259 (27%) X 306 (32%) X X X

Fonte: autores, 2018.

168


DISCUSSION

To compare the clinical profile between

men and women with AMI, a study published

in 2014 showed that the coefficient of overall

mortality is higher among men in relation to

women, in all the years considered. However,

the variable SAH, when compared their

frequency between genders, we found

a higher incidence among women (p=0.001),

while smoking and alcoholism were more

frequent in men (p=0.01).16

There are several risk factors associated

with AMI, among them: marital status, being

retired, family history of coronary artery

disease; antecedents of SAH and DM, TB,

physical activity, LDL-cholesterol, HDL-

cholesterol, glucose, body mass index, among

others.1-5,12-14,16-21,23, 26-28

In 2007,29 was conducted a study with

50 patients, whose goal was to identify the

epidemiological profile of patients with

cardiovascular diseases. This showed that

32% of the patients were smokers or had

stopped smoking after a cardiac event.

Another important variable was the

hypercholesterolemia, present in 44%

of patients affected by any cardiac event.

Another study performed in 2015,30

demonstrated a significant relevance in the

influence of genetic factor/family history

when analyzed the pathophysiology of AMI

and its possible predisposing factors in

individuals aged less than 40 years.

In this sense, the increase in cholesterol

and the presence of TB are important risk

factors for the onset of AMI. These and other

factors such as being overweight

and hypertension, in addition to contributing

to the emergence of a coronary event, also

interfere in the quality of life and the survival

of the population. Therefore, the

development of preventive strategies, health

education and screening of the population at

risk are fundamental and allow screening,

control and prevent these risk factors, thus

ensuring better quality of life of the

population and to reduce the incidence of

coronary events.

To conduct a survey of data between

2002 and 2003, it was demonstrated that the

age above 60 years is a factor on

the hospitalization rate and an indicator of the

severity and mortality of patients with

ischemic heart diseases.31

Another study conducted in 2009 with

64 patients hospitalized for ACS pointed

out that 54.7% of the patients presented

dyslipidemia, 93.8% were hypertensive,

26.6% were smokers, 37.5% diabetic patients

and 67.2% were sedentary.32

Thus realizes that there are several risk

factors that may favor the appearance of

AMI/ACS (internal and external). The most

effective way to combat these

risks and reduce the impact of cardiovascular

diseases at the population level, is the

development of preventive actions. For this

reason, the multidisciplinary team is

indispensable in this process, working in

active search and identification and

intervention of external factors and proposing

educational strategies that minimize the risk

of ACS by internal factors.

As regards the treatment of ACS, there

are several types of drugs that can be used in

the management of this pathology, since the

arrival of the patient in the emergency unit,

until their hospital discharge. These

medicines may vary according to the degree

of involvement and the time of manifestation

of symptoms. The most widely used in the

initial management are: acetylsalicylic acid,

clopidogrel, ticlopidine, ntitrombínicos,

nitroglycerin, nitrates, tirofiban and

169


abciximab, inhibitors of angiotensin

converting enzyme,

statins, bloqueadores calcium, beta-

blockers among others. 33

Intravenous thrombolysis or

fibrinolysis is an important procedure in the

first minutes after AMI, but in patients with

IAMCST eligible for rescue

angioplasty (primary angioplasty) is

fundamental and must be performed by an

experienced team in up to 12 h after the onset

of symptoms.34

Still lack clarity in studies regarding the

combination between the therapies already

imposed (thrombolysis, the use of antiplatelet

drugs, betablockers and/or angiotensin-

converting enzyme and the angioplasty),

especially regarding its effectiveness in

saving lives.35

Another study conducted in

2007,36 showed that 483 patients were

followed up for quality of life assessments

and demographic profile questionnaire.

These patients have formed the following

therapeutic groups: surgical myocardial

revascularization (SMR), 161

patients (33.3%), percutaneous coronary

angioplasty (PCI), 166 patients (34.3%), and

medical treatment (MT), 153 patients

(32.4%), being periodically monitored. In this

study it was possible to verify that patients in

the three therapeutic options were similar

when related to clinical and angiographic

conditions, medication use, laboratory,

among others. Of the patients in follow-up,

86% had, on admission to the study, anginal

symptoms class II or III (CCS); 34% reported

the occurrence of myocardial infarction; 32%

were smokers.

In this study, all patients received

specific medications for cardiac impairment

and other comorbidities. In relation to the

clinical treatment after the period of four

years of follow-up, of the 153 patients

referred, 12 (7.7%) were victims of AMI, 24

(15.3%) were submitted to myocardial

revascularization surgery and 19

(12.1%), evolved to death. In addition, five

patients (3.1%), suffered a stroke and 40

(25.6%) reported symptoms of

angina pectoris.36

Therefore, it is striking that the

treatment related to AMI/ACS is varied and

depends on the time of the clinical status and

diagnosis of the patient affected. Thus, the

rapid and correct definition of therapeutics

instituted ahead, as well as the treatment and

control of these comorbidities, pipelines are

indispensable to the effectiveness of the

proposed treatment and better outcomes in

these patients.

Conclusion

After analysis of the information, it can

be argued that the SCA still presents a serious

public health problem and needs to be tackled

on a daily basis.

As regards the risk factors for the onset

of AMI, we observed that there are several

responsible for unleashing this pathology.

Among the most frequent found the

TB, SAH, DM, followed of sedentary

lifestyle and overweight. External factors

such as family history were also evident in

studies, but less often. Another important fact

noticed in studies was that the patients with

AMI, had in common, the presence of two or

more risk factors concurrently, suggesting

that the risk factors in conjunction, potentiate

the risk of an ischemic event.

The information raised demonstrate the

need for public health policies and health

education strategies to the population, in

order to prevent these risk factors and control

170


them in that possesses them. Another fact was

evidenced the need for active search and

tracking of the population at risk in the

community, in order to guide them as to the

risk of developing ACS and about

the importance of the quick search by a

hospital unit in the presence of early signs and

symptoms. These practices require

knowledge and commitment of health

professionals, especially

nurses, who constantly plays in the promotion

of health and prevention of diseases in the

population.

Regarding gender affected by AMI, we

observed a predominance of males among

patients with AMI in comparison to the

female gender. However, the incidence of

SCA in the female population seems to be

growing in recent years.

As a limitation found in this review, is

the lack of intervention studies, which limits

the statements listed here. Another critical

point was the fact that few studies have

analyzed the stress as an important risk factor

for the development of ACS, since this

factor is frequent in actuality.

REFERENCES

1. Jesus AV, Campelo V, Silva MJS. Perfil

dos pacientes admitidos com Infarto Agudo

do Miocárdio em Hospital de Urgência de

Teresina-PI. Rev. Interd. 2013; 6(1):25-33.

2. Araújo IFM, Santos ISC, La Longuiniere

ACF, Valença Neto PF, Franklin TA. Profile

of the population affected by acute

myocardial infarction. Rev. enferm. UFPE

on line. 2016. [acesso em: 11 nov

2018];10(7):2302-9. Disponível em:

file:///C:/Users/biare_000/Downloads/11284

-25528-1-PB%20(1).pdf.

3. Torres GKV, Marques IR. Estudo sobre o

perfil dos pacientes portadores de Síndrome

Coronariana Aguda. Rev. Enferm. UNISA.

2012; 13(1):21-6.

4. Piegas LS, Avezum A, Guimarães HP,

Muniz AJ, Reis HJL, Santos ES, et al. Acute

Coronary Syndrome Behavior: Results of a

Brazilian Registry. Arq. Bras. Cardiol. 2013;

100(6):502-10.

5. Mozaffarian D, Benjamin EJ, Go AS,

Arnett DK, Blaha MJ, Cushman M, et al.

Heart disease and stroke statistics, 2015

update: a report from the American Heart

Association. Circulation. 2015;131:e29–

e322.

6. Andrade PB, Rinaldi FS, Bienert IRC,

Barbosa RA, Bergonso MH, Matos MPB, et

al. Clinical and angiographic profile of

young patients undergoing primary

percutaneous coronary intervention. Rev

Bras Cardiol Invasiva. 2015;23(2):91-5.

7. Damasceno CA, Queiroz TL, Santos

CAST, Mussi FC. Factors associated with

the decision to seek health care in

myocardial infarction: gender diferences.

Rev. Esc. Enferm. USP. 2012; 46(6):1362-

70.

8. Soares T, Souza EN, Moraes MA, Azzolin

K. Tempo Porta-Eletrocardiograma (ECG):

um indicador de eficácia no tratamento do

infarto agudo do miocárdio. Rev. Gaúcha

Enferm. 2009; 30(1):120-6.

9. Bahall M, Seemungal T, Legall G. Risk

factors for first-time acute myocardial

infarction patients in Trinidad. BMC Public

Health. 2018;18(1):161.

10. Fernández-Rodríguez D, Regueiro A,

Cevallos J, Bosch X, Freixa X, Trilla M, et

al. Gender gap in medical care in ST

segment elevation myocardial infarction

networks: Findings from the Catalan

network Codi Infart. Medicina Intensiva,

2017;41(2):70-7.

11. Marino BCA, Marcolino MS, Reis

Júnior RS, França ALN, Passos PFO, Lemos

TR, et al. Epidemiological Profile and

Quality Indicators in Patients with Acute

Coronary Syndrome in Northern Minas

Gerais – Minas Telecardio 2 Project. Arq.

Bras. Cardiol. [online]. 2016. [acesso em: 5

jan 2018]; 107(2):106-15. Disponível em:

http://dx.doi.org/10.5935/abc.20160095.

12. Maier GSO, Martins EAP, Dellaroza

MSG. Pre hospital indicators in assessing the

quality of care for patients with acute

coronary syndrome. Rev. Gaúcha Enferm.

2015; 36(3):49-55.

13. Soeiro AM, Fernandes FL, Soeiro MC,

Serrano Jr CV, Oliveira Jr MT. Clinical

characteristics and long-term progression of

young patients with acute coronary

syndrome in Brazil. Einstein (São Paulo).

2015;13(3):370-5.

14. Andrade KBS, Pinheiro APB, Bessa

ATT, Paes GO, Stipp MAC. A avaliação do

tempo de espera do eletrocardiograma inicial

em pacientes com Síndrome Coronariana

Aguda. Rev. enferm. UERJ. 2015;

23(4):443-8, 2015.

http://dx.doi.org/10.5935/abc.20160095

171


15. Sousa AG, Fichino MZS, Silva GS,

Bastos FCC, Piotto RF. Epidemiology of

coronary artery bypass grafting at the

Hospital Beneficência Portuguesa, São

Paulo. Braz J Cardiovasc Surg

2015;30(1):33-9

16. Almeida MCA, Montenegro CEL,

Sarteschi C, Montenegro GL, Montenegro

PBR, Livera JR, et al. Comparação do Perfil

Clínico-Epidemiológico entre Homens e

Mulheres na Síndrome Coronariana Aguda.

Rev. Bras. Cardiol. 2014; 27(6):423-9.

17. Araújo DF, Araújo ERM, Silva MRV,

Silva NC, Guimarães MSO, Amorim Neta

FL. Perfil clínico e epidemiológico de

pacientes com síndrome coronariana aguda.

Rev. Enferm. UFPI. 2014; 3(2):78-84.

18. Lima MSM, Dantas RAN, Mendes NPN,

Alves LCM, Silva TTM, Brito AGR, et al.

Clinical-epidemiological aspects of patients

submitted to Percutaneous Coronary

Intervention in a university hospital. Rev

Bras Enferm. 2018;71(6):2883-90.

19. Deora S, Kumar T, Ramalingam R,

Nanjappa Manjunath C. Demographic and

angiographic profile in premature cases of

acute coronary syndrome: analysis of 820

young patients from South India. Cardiovasc

Diagn Ther. 2016;6(3):193–198.

20. Agrawal V, Lohiya BV, Sihag BK,

Prajapati R. Clinical Profile with

Angiographic Correlation in Naïve Acute

Coronary Syndrome. J Clin Diagn Res.

2016;10(9):OC10–OC14.

21. Silva LN, Karino ME, Martins JT,

Galdino MJQ, Scholze AR, Ribas JJ.

Epidemiological and clinical profile of

patients with acute coronary syndrome. J

Nurs UFPE on line. 2018; 12(2):379-85.

22. Egholm G, Madsen M, Thim T, Schmidt

M, Christiansen EH, Bøtker HE et al.

Evaluation of algorithms for registry-based

detection of acute myocardial infarction

following percutaneous coronary

intervention. Clin Epidemiol 2016;8:415–23.

23. Pogorevici A, Citu IM, Bordejevic DA,

Caruntu F, Tomescu MC. Canada acute

coronary syndrome score was a stronger

baseline predictor than age ≥75 years of in-

hospital mortality in acute coronary

syndrome patients in western Romania. Clin

Interv Aging. 2016;11:481–488.

24.Hayıroğlu MI, Çanga Y, Yıldırımtürk O,

Bozbeyoğlu E, Gümüşdağ A, Uzun AO, et

al. Clinical characteristics and outcomes of

acute coronary syndrome patients with intra-

aortic balloon pump inserted in

intensivecardiac care unit of a tertiary clinic.

Turk Kardiyol Dern Ars. 2018; 46(1):10-7.

25. Grieshaber P, Oster L, Schneider T, et al.

Total arterial revascularization in patients

with acute myocardial infarction - feasibility

and outcomes. J Cardiothorac Surg.

2018;13(1):2.

26. Ong ME, Hao Y, Yap S, Pek PP, Chua

TS, Ng FS, et al. Validation of the new

Vancouver Chest Pain Rule in Asian chest

pain patients presenting at the emergency

department. CJEM. 2017; 19(1):18-25.

27. Schmidt MM, Quadros AS, Martinelli

ES, Gottschall CAM. Prevalence, etiology,

and characteristics of patients with type‐2

acute myocardial infarction. Rev Bras

Cardiol Invasiva. 2015;23(2):119-23

28. Jensen MT, Pereira M, Araujo C,

Malmivaara A, Ferrieres J, Degano IR et al.

Heart rate at admission is a predictor of in-

hospital mortality in patients with acute

coronary syndromes: Results from 58

European hospitals: The European Hospital

Benchmarking by Outcomes in acute

coronary syndrome Processes study. Eur

Heart J Acute Cardiovasc Care.

2018;7(2):149-57.

29. Jaconodino CB, Amestoy SC, Thofehrn

MB. Conhecimento dos pacientes acerca dos

fatores de risco relacionados às doenças

cardiovasculares. Cogitare Enfermagem.

2007; 12(4):466-71.

30. Feijó IP, Schmidt MM, David RB,

Martins JMP, Schmidt KE, Gottschall CAM,

et al. Percutaneous Coronary Intervention in

Young Patients. Rev Bras Cardiol Invasiva.

2015; 23(1):48-51.

31. Evangelista PA, Barreto SM, Guerra HL.

Hospital Admission and Hospital Death

Associated to Ischemic Heart Diseases at the

National Health System (SUS). Arq. Bras.

Cardiol. 2008; 90(2):130-8.

32. Pena FM, Peixoto RS, Soares JS, Pires

Júnior HR, Pena GSA, Rosa Netto MV, et

al. Perfil clínico e angiográfico de pacientes

idosos com síndrome coronariana aguda

admitidos em hospital terciário. Rev.

SOCERJ. 2009; 22(3):176-80.

33. Santos ES, Minuzzo L, Pereira MP,

Castillo MTC, Palácio MAG, Ramos RF, et

al. Acute Coronary Syndrome Registry at a

Cardiology Emergency Center. Arq. Bras.

Cardiol. 2006; 87:597-602.

34. Ibanez B, James S, Agewall S, Antunes

MJ, Bucciarelli-Ducci C, Bueno H, et al.

2017 ESC guidelines for the management of

acute myocardial infarction in patients

presenting with ST-segment elevation: The

Task Force for the management of acute

myocardial infarction in patients presenting

with ST-segment elevation of the European

Society of Cardiology (ESC). Eur Heart J

2018;39:119–177.

35. Baena CP, Olandoski M, Luhm KR,

Costantini CO, Guarita-Souza LC, Faria-

Neto JR. Tendency of Mortality in Acute

Myocardial Infarction in Curitiba (PR) in the

172


period of 1998 to 2009. Arq. Bras. Cardiol.

2012;98(3):211-7.

36. Takiuti ME, Hueb W, Hiscock SB,

Nogueira CRSR, Girardi P, Fernandes F, et

al. Quality of Life after Surgical Myocardial

Revascularization, Angioplasty or Medical

Treatment. Arquivos Brasileiros de

Cardiologia. 2007; 88(5):537-44.

RECEIVED: 09/01/2019

APPROVED: 17/07/2019

PUBLISHED: 07/2020

factors associated with acute coronary syndrome …

Documents